What are CGRP Monoclonal Antibodies?
CGRP monoclonal antibodies: Quick Look
| Use | Prevent migraine, typically used for people with chronic or severe migraines. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Effectiveness | Proven effectiveness in large, high-quality clinical trials. | ||||||||||
| Migraine-specific? | Yes | ||||||||||
| Prescription? | Yes | ||||||||||
| Side effects | Allergic reaction to the drug, injection site reaction | ||||||||||
| Taken how? | Injection (Aimovig, Ajovy, Emgality) Intravenous infusion (Vyepti) | ||||||||||
| Drugs in this class |
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CGRP (calcitonin gene-related peptide) monoclonal antibodies prevent migraine. The approval of the first CGRP antibodies in 2018 was a breakthrough in migraine treatment. They were the first migraine-specific preventive drugs. There are currently 4 approved CGRP antibodies. CGRP antibodies do not stop a migraine attack once it has started.
How are the trigeminal nerve and CGRP connected?
Migraine is a result of dysfunctional nerve signaling. Key players are the trigeminal nerves and CGRP, a signaling molecule. The trigeminal nerve runs from the brain to the face. It is responsible for sensation in the face and head, and some jaw movement.
CGRP is a small protein that transmits signals in the brain. Sensory nerves produce and release CGRP. Drugs that block CGRP help prevent and treat migraine. Other names for this class of drugs are: CGRP mAbs, CGRP inhibitors, or CGRP antagonists.
How do CGRP antibodies work?
CGRP antibodies disrupt the CGRP process. The lock-and-key analogy is helpful for understanding how they do this. The CGRP protein is the key. The CGRP receptor is the lock. When the key opens the lock, the pain process begins or worsens. Drugs that block the lock or change the shape of the key interfere with the function of CGRP and are useful treatments for migraine.
One CGRP antibody blocks the “lock:”1
Three other CGRP antibodies attach to the “key”:2-4
Do CGRP antibodies work for episodic migraine?
In general, CGRP antibodies prevent 3 or 4 migraine days per month for people with episodic migraine. This is an average, so your results may be better or worse. For comparison, the beta-blockers and anticonvulsants approved for migraine prevent about 1 to 2 migraine days per month. Results from clinical trials of CGRP antibodies found:5-8
- 4.7 fewer migraine days per month with Emgality
- 3.9 fewer migraine days per month with Vyepti
- 3.7 fewer migraine days per month with Ajovy
- 3.2 fewer migraine days per month with Aimovig
Do CGRP antibodies work for chronic migraine?
In general, CGRP antibodies prevent 4 to 7 migraine days per month for people with chronic migraine. This is an average, and results vary from person to person. Clinical trials showed these results:9-12
- 7.6 fewer migraine days per month with Vyepti
- 6.6 fewer migraine days per month with Aimovig
- 5 fewer migraine days per month with Ajovy
- 4.6 fewer headache days per month with Emgality
How are Aimovig, Emgality, Ajovy, and Vyepti different?
The 4 CGRP antibodies are taken on different schedules and in different ways.1-4
- Aimovig and Emgality are given by injection once a month. Emgality requires a “loading dose,” which is the first dose of the drug. This is usually 2 injections to start, then a monthly injection after that.
- Ajovy is given by injection every 1 or 3 months.
- Vyepti is given as a 30-minute infusion once every 3 months.
Each of these drugs work in a slightly different way. All are effective at preventing migraine and have similar side effects.
What are the possible side effects?
The side effects of CGRP antibodies are generally mild or moderate. Redness or pain at the injection site is common. A small number of people had an allergic reaction to the drugs. Some people treated with Vyepti in clinical trials had an upper respiratory infection (cold).1-4,9-12
Aimovig was linked to constipation and new or worsening high blood pressure. Doctors now monitor people taking Aimovig for rising blood pressure. You may need to take a different migraine drug if there is no other cause for your increasing blood pressure.1
Side effects can vary depending on the specific drug taken.
These are not all the possible side effects of CGRPs. Talk to your doctor about what to expect or if you notice any changes that concern you during treatment.
How are gepants different?
There is a family of drugs called the CGRP gepants, such as Ubrelvy™ and Nurtec™. Because the drug families have similar names, CGRP antibodies and CGRP gepants are sometimes confused. Both monoclonal antibodies and gepants target CGRP. However, these drugs have different purposes. CGRP antibodies prevent migraine. Gepants are acute treatments taken at the start of an attack.17,18
What are the 4 letters at the end of the scientific name?
Many drugs have 2 names. There is a brand name, such as Aimovig, Ajovy, Emgality, or Vyepti. There is also a scientific name, such as erenumab-aooe, fremanezumab-vfrm, galcanezumab-gnlm, or eptinezumab-jjmr.
You may have wondered about the 4 letters at the end of the scientific name. A deeper dive explains their purpose. The CGRP monoclonal antibodies are biologic drugs. Biologic drugs are proteins made from the cells of living organisms. They are much more complex than conventional drugs.
A biosimilar is very much like the original biologic. But it is not exactly alike. The FDA wanted the names to reflect this. So biologics and their biosimilars share a scientific name, but each has its own 4-letter suffix.19
Before beginning any migraine treatment, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.
